When President Barack Obama put his signature to the American Recovery and Reinvestment Act—also known as ARRA, or “Stimulus #1”—on February 17, 2009, he also enacted legislation to accelerate the adoption of electronic health records across the United States: the Health Information Technology for Economic and Clinical Health, or HITECH, Act.

HITECH authorizes substantial payments to physicians, and to hospitals, if they 1) utilize a government-certified electronic health record (EHR) and 2) demonstrate that they are using that EHR in a manner that advances the quality of health care—the so-called meaningful use.

On July 13, 2010, the federal government issued final rules about requirements for eligible EHR systems and reporting criteria for clinicians to demonstrate their meaningful use of the EHR. The program officially began on January 1, 2011.

TABLE 1

The 3 stages of meaningful use of an EHR

Stage of use

What is the main goal of this stage?

By what will attainment of that goal be measured?

Stage 1

To capture and share data

By use of information in the EHR to track key clinical problems

By communication, broadly and seamlessly, of key information to all care providers involved with the patient

By reporting of practice-level quality measures

Stage 2

To exchange clinical data

To advance electronically enhanced clinical processes

By use of the EHR for disease management and clinical decision support

By management of drug interactions and allergies using the EHR

By an increase in patients’ direct access to their EHR

By demonstration of bidirectional electronic data sharing with public health agencies

Stage 3

To improve clinical outcomes

By demonstration of improvements in quality, safety, and efficiency

By utilization of advance decision support within the EHR

By development of patient self-management tools within the EHR

By improvement in population and public health outcomes

TABLE 1 provides an overview of the three proposed stages of the HITECH Act. TABLE 2, page 10, is a timeline of the payment schedule for each year and stage of the HITECH program.

TABLE 2

Schedule of maximum government payments to a qualifying* physician

Year in which you begin meaningful use

What is the highest annual payment you can receive?

2011

2012

2013

2014

2015

2016

Total payments

2011

Stage 1 $18,000

Stage 1 $12,000

Stage 2 $8,000

Stage 2 $4,000

Stage 3 $2,000

Stage 3 0

$44,000

2012

Stage 1 $18,000

Stage 1 $12,000

Stage 2 $8,000

Stage 3 $4,000

Stage 3 $2,000

$44,000

2013

Stage 1 $15,000

Stage 2 $12,000

Stage 3 $8,000

Stage 2 $4,000

$39,000

2014

Stage 1 $12,000

Stage 3 $8,000

Stage 3 $4,000

$24,000

2015

0

0

0

The schedule is “front-loaded”: The largest payments are made in the first 2 years of the program. Physicians receive payments based on when they start the program. The maximum payment that a physician can receive under the Medicare rules is 75% of the professional part B allowable charges you have submitted to Medicare in the calendar year. Example: To collect the full payment of $18,000 in 2011, you must submit $24,000 in allowable professional charges to Medicare. Physicians who practice in a health-care provider shortage area receive an additional 10% of their qualifying amount.

*“Qualifying” refers to those who 1) utilize a certified EHR, in 2) a meaningful manner, under 3) Medicare rules for the program

You must show “meaningful use” of your certified EHR

In the first year of the program, you must be using a certified EHR and must demonstrate meaningful use of that record over any 90-day period within the payment year (2011 or 2012).

In the second year, and beyond, the reporting period will be the entire calendar year.

Here are some of the initial rules for demonstrating meaningful use:

You can qualify for the program through either of two mechanisms: 1) participation in Medicare and 2) through Medicaid, if 30% or more of patient encounters are with Medicaid patients. Maximum reimbursements are $44,000 and $64,000 under the Medicare and Medicaid programs, respectively. Under Medicare rules (the more common way to achieve meaningful use), all physicians qualify (midlevel providers do not qualify). Under Medicaid rules, physicians, physician assistants, nurse midwives, and nurse practitioners qualify.

Through an Internet portal (yet to be established), you must register your EHR to determine if it is certified by the government

50% or more of your patient record documentation must be in a certified EHR